1265898100 NPI number — SYLVIA M GONZALEZ M.S.CCC.SLP

NPI Number: 1265898100
Health Care Provider/Practitioner: SYLVIA M GONZALEZ M.S.CCC.SLP

NPI Number : 1265898100 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265898100",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GONZALEZ",
    "FirstName": "SYLVIA",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.S.CCC.SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SIMPSON",
    "OtherFirstName": "SILVIA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "M.S.CCC.SLP",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "3410 STAGE COACH TRL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WEATHERFORD",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76087-8266",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "817-925-8835",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3410 STAGE COACH TRL",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WEATHERFORD",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76087-8266",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "817-925-8835",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/07/2016",
    "LastUpdateDate": "07/22/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "114348",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "SLP16037",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}